The Senate narrowly confirmed President Joe Biden’s pick to lead the Food and Drug Administration on Tuesday pushing past a thicket of political controversies that threatened to derail what was initially expected to be an easy confirmation.

       The 50-46 vote means Dr. Robert Califf, a cardiologist and prominent medical researcher, will again lead the powerful regulatory agency, which he briefly headed during the end of President Barack Obama's administration.

       The FDA hasn’t had a permanent leader in more than a year despite playing a central role in the COVID-19 response effort, reviewing the vaccines, drugs and tests used to fight the pandemic.

       The razor-thin vote underscores the increasing political polarization around the health care issues FDA oversees and contrasts with Califf’s overwhelming support just six years ago. The Senate previously confirmed him to the job by a vote of 89-4.

       Califf now inherits a raft of reviews and decisions pending at the agency, which regulates several multibillion-dollar industries, including prescription and over-the-counter drugs, medical devices, tobacco products and most foods.

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